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J Hepatol:注射毒品人群中丙型肝炎再感染率随着高效直接抗病毒药物(DAA)使用的扩大而同期上升

2021-10-15 MedSci原创 MedSci原创

在苏格兰注射毒品(PWID)的人群中扩大丙型肝炎病毒(HCV)的高效直接抗病毒药物(DAA)使用,降低了该人群中病毒血症的患病率。然而,接受DAA治疗的患者的再感染程度仍不确定。我们通过治疗环境、引入

在苏格兰注射毒品(PWID)的人群中扩大丙型肝炎病毒(HCV)的高效直接抗病毒药物(DAA)使用,降低了该人群中病毒血症的患病率。然而,接受DAA治疗的患者的再感染程度仍不确定。我们通过治疗环境、引入DAA前后以及不完整随访检测导致的未确诊再感染的潜在数量,估计了苏格兰PWID中HCV再感染率。

方法

通过链接国家临床和实验室HCV数据,对2000-2018年间开始治疗并获得持续病毒学应答(SVR)的PWID回顾性队列进行随访,直至2019年12月再感染。再感染定义为HCV抗原或RNA检测阳性。

结果

在5592例PWID中的5686例SVR中,4126例(73%)在SVR后进行了HCV RNA或抗原检测。在复检的患者中,我们确定了361例再感染(3.9/100人年(PY))。再感染率从2000-2009年接受治疗的PWID的1.5/100 PY增加至2017-2018年的8.8/100 PY在监狱(14.3/100 PY)和社区环境(9.5/100 PY)治疗的患者中观察到再感染率最高在DAA时代(2015-2018年)接受治疗的患者中,68%在SVR后第一年接受检测,但仅30%在第二年接受检测;虽然随访期间诊断出169例再感染,但估计有200例再感染(占估计总数的54%)未被检测到。

图:1. 基于社区的治疗途径正在惠及被认为对消除病毒至关重要的高危群体;

2.在监狱和社区环境治疗的患者中观察到再感染率最高

3.HCV复检率较低

 

 

结论

苏格兰PWID中HCV再感染率随着DAA的扩大而同期上升,基于社区的治疗途径正在惠及被认为对消除病毒至关重要的高危群体。然而,我们估计,在DAA时代,由于在治疗成功后的第一年之后的复查水平不足,不到一半的再感染被发现。在PWID中促进SVR后HCV检测对于确保再次感染的患者被及时发现并再治疗至关重要

原文链接:https://pubmed.ncbi.nlm.nih.gov/34634387/

Population-level estimates of hepatitis C reinfection post scale-up of direct-acting antivirals among people who inject drugs

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    2022-09-04 zywlvao
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    2021-10-17 yahu
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    2021-10-17 qingting
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    2021-10-17 gwc384
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